NEMT Startup Costs in 2026: Vehicle, Fees, Insurance, and Cash Reserve
Most of the cost to start a NEMT business is the vehicle and the cash to run it until payers pay. A new ramp minivan on Florida's state transit contract lists at $69,476 before options. Filing fees, the EIN, and the NPI cost little or nothing, and NEMTAC recommends holding three to six months of operating expenses in reserve.
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The cost to start a NEMT business comes down to two big numbers and a list of small ones. The big numbers are the vehicle and the cash you need to run for several months before payers pay you. The small ones are filing fees, permits, screening, and equipment, and several of the most important steps are free.
This page lists each cost with a real, published figure where one exists, then adds them up in a labeled example. Use the NEMT startup cost calculator to swap in your own numbers.
One-time startup costs
These are the costs you pay before or during your first month. Figures are published fees and prices as of September 2026.
| Item | Cost | Notes |
|---|---|---|
| LLC or corporation filing | $300 in Texas, $125 in Florida | California LLCs also owe an $800 annual tax to the Franchise Tax Board |
| EIN | $0 | Issued free and online by the IRS |
| NPI | $0 | Issued free by CMS through NPPES |
| Medicaid application fee | $750 in 2026 | Federal fee, waived if already paid to Medicare or another state |
| Ramp minivan, new | $69,476 before options | Florida’s state transit contract price for a Braun ADA Chrysler Voyager |
| Two-camera system | $1,610 to $3,243 | Option prices on the same Florida contract |
| Extra wheelchair tie-down set | $264 | Option price on the same contract |
| City or state operating permits | $0 to $1,550 in these examples | None statewide in Texas; Pennsylvania PUC $350 for each class of service; NYC TLC paratransit base $1,000 plus $550 per vehicle, each for two years |
| Florida Medicaid surety bond | Varies | Required on AHCA’s form unless you contract through the transportation coordinator |
| Driver screening and training | Varies | Background checks, drug screens, motor vehicle records, CPR and passenger assistance courses |
| Website, signage, and marketing | Your budget | Vehicle lettering, a website, and printed material for facilities |
| Insurance deposit | Your quote | See the insurance section below |
A few costs arrive later. NEMTAC accreditation costs $3,000 up front or $3,600 on a monthly plan, but you cannot apply until you have 12 months in service. Medicaid enrollment must be revalidated at least every five years, and the application fee can apply again then.
The vehicle: your biggest purchase
The vehicle decides most of your startup budget, so choose it after you know which riders you will carry. Ambulatory-only service can run in any clean, insured passenger vehicle. Wheelchair service needs a ramp or lift van with securement equipment. Stretcher service needs a stretcher van and may need a second attendant under your state’s rules.
Florida’s TRIPS program publishes a public price list for accessible minivans. Its contract TRIPS-19-MV prices a Braun ADA lowered-floor Chrysler Voyager at $69,476 before options, listed with up to 6 seats and 2 wheelchair positions. That is what public agencies pay under a negotiated contract, so treat it as a reference point for a new conversion rather than a dealer quote.
Three ways to spend less on the vehicle:
- Buy used. A used ramp van costs less, but get an independent inspection of the ramp, the securements, and the floor before you buy. Brokers inspect them too.
- Lease or finance. A monthly payment replaces the purchase price and leaves cash for insurance and reserves.
- Start ambulatory. A standard minivan costs less, although the rates are lower as well.
Plan for a backup. NEMTAC’s startup checklist recommends reserve vehicles equal to 10 to 20 percent of your fleet. With one or two vans, that usually means a written arrangement for a rental or a partner provider. Our best vehicles for NEMT guide compares van types.
Insurance: set by your quote, bounded by minimums
Insurance is priced on your drivers, your vehicles, your service area, and your claims history, so the only reliable number is a quote. What you can know in advance is the minimum coverage your state and payers require:
| Requirement | Minimum |
|---|---|
| Florida Medicaid enrollment | $100,000 per person and $200,000 per incident liability |
| Louisiana Medicaid managed care | $25,000/$50,000/$25,000 split limits or a $300,000 combined single limit |
| California CPUC permit holders | $750,000 combined single limit for vehicles carrying up to 8 people, including the driver |
| Federal rule for interstate for-hire trips | $1.5 million for vehicles seating 15 or fewer, including the driver |
Broker contracts often require more than the state floor, plus general liability and workers’ compensation. Get the broker’s insurance requirements in writing, then ask two or three agents who write NEMT policies to quote them. Our NEMT insurance cost guide explains what moves the premium.
Monthly operating costs
Once you run trips, four costs repeat every month.
- Driver pay. The May 2025 median wage for shuttle drivers and chauffeurs was $17.93 an hour, before payroll taxes and any benefits. Pay in your area may differ. See NEMT driver pay.
- Vehicle running costs. The IRS business mileage rate, based on an annual study of the fixed and variable costs of operating a car, is 76 cents a mile for July through December 2026. Use it as a starting benchmark and replace it with your own fuel, maintenance, and insurance numbers once you have them.
- Insurance. Your quote, usually paid monthly.
- Software and phones. Per-vehicle prices for NEMT dispatch software commonly run about $49 to $69 a month, and some vendors charge a flat monthly fee or a fee per trip instead. Our NEMT software pricing page compares them.
Unpaid miles belong in this budget. Medicaid generally does not pay separately for miles driven with nobody aboard, including the drive back after a rider no-shows, although CMS lets states build those costs into their rates. Our guide on reducing deadhead miles shows where they come from.
Working capital: the cost new owners forget
You pay drivers, fuel, and insurance before payers pay you. That gap is why NEMTAC’s startup checklist recommends starting with three to six months of operating expenses in the bank. Broker and facility payment schedules are set in each contract, so ask how often they pay before you sign, and size your reserve to the slowest payer you plan to serve.
Example budget: one wheelchair van
The numbers below are a hypothetical example built from the published line items above, not a quote. It assumes one new ramp minivan bought outright in Texas, one hired driver working 9 paid hours a day on 22 days a month, and 100 total miles a day.
Monthly running cost (before insurance):
| Line | Math | Monthly |
|---|---|---|
| Driver | 198 hours at $17.93 | $3,550 |
| Vehicle | 2,200 miles at 76 cents | $1,672 |
| Software | Middle of the published range | $60 |
| Total before insurance | $5,282 |
Cash to launch:
| Line | Low | High |
|---|---|---|
| Texas LLC filing | $300 | $300 |
| EIN and NPI | $0 | $0 |
| Medicaid application fee | $750 | $750 |
| Ramp minivan | $69,476 | $69,476 |
| Camera system | $1,610 | $3,243 |
| Reserve, 3 to 6 months of running cost | $15,846 | $31,692 |
| Total before insurance | $87,982 | $105,461 |
Two notes on the math. The IRS mileage rate includes fixed ownership costs as well as fuel and repairs, so it overstates the monthly cash you spend on a van you already own, which gives the reserve some cushion. If you finance the van instead, the $69,476 line becomes a down payment, and the monthly payment moves into running costs.
Ways to spend less at launch
The fastest savings come from sequencing, not from cutting safety.
- Drive the first van yourself. An owner-operator removes the largest monthly cost until trip volume justifies a hire. See starting with one van.
- Start with one service level. Adding stretcher service later is easier than paying for it before you have the riders.
- Line up work before you buy. A facility contract or a broker credentialing approval in progress tells you the van will be busy.
- Look for contract work funded by transit grants. Federal Section 5310 money flows to nonprofits, public agencies, and public transit operators, and Georgia’s state plan, for example, buys rides through service contracts that include for-profit providers. Our NEMT business funding guide covers it.
Budgeting for software
Software is one of the smallest lines in the budget, so pick it for fit, not just price. HealthRide costs $59 per vehicle per month, month-to-month, with no setup fees. A one-van company pays for one van and gets the same dispatch board, driver app, and invoicing as a larger fleet. See pricing for what is included.
Frequently asked questions
- What does a one-van NEMT launch cost?
- In our example, one new ramp minivan bought outright in Texas, plus filing fees, the 2026 Medicaid application fee, a camera system, and three to six months of running costs, comes to about $88,000 to $105,000 before insurance. Financing or a used van lowers the cash you need up front. Your insurance quote is the other big number.
- Is it cheaper to start with ambulatory rides only?
- The vehicle is cheaper, because ambulatory riders do not need a ramp or lift. The rates are lower too. Colorado's July 2026 fee schedule pays a $12.15 base for taxi and mobility van trips and $34.14 for wheelchair van trips, both plus $2.74 per mile. Run the numbers on both before you choose.
- Is there a fee for an EIN or an NPI?
- No. The IRS issues EINs free, and the IRS warns against websites that charge for one. CMS issues NPIs free through the NPPES website. Any company that charges you is charging for help filling out a free form.
- Does the Medicaid application fee apply to NEMT companies?
- Usually. States must collect the federal application fee from providers other than individual practitioners, unless the provider already paid it to Medicare or another state. The fee is $750 for applications submitted in 2026. Texas, for example, tells applicants inside its enrollment system whether the fee applies.
- How much does NEMTAC accreditation cost?
- NEMTAC charges $3,000 paid up front or $3,600 on a monthly plan, both including a $600 nonrefundable application fee. You cannot apply until you have 12 months in service, so it is a year-two cost, not a startup cost.
- Can I lease a wheelchair van instead of buying one?
- Yes. Leasing and financing trade the large purchase price for a monthly payment, which leaves more cash for insurance and operating reserves. Compare the total cost over the term, and confirm the lease allows commercial passenger use and the equipment your broker requires.
